The long-range goal of this research is to provide a scientific basis for rehabilitation of individuals with hearing impairment. Although it is known that hearing loss has detrimental effects on communication and psychosocial functioning, there are no systematic or comprehensive studies of psychosocial and behavioral adjustment to hearing impairment. To address this need, we will establish a multi-center clinical database on a heterogeneous population of hearing-impaired adults. Study 1 will assess communication handicap, environmental factors that exacerbate communication problems, behavioral coping strategies, and personal adjustment in a representative sample of 2,500 hearing-impaired adults. Normative data will be compiled as a function of audiometric and demographic factors. In Study 2, 1,000 cases from Study 1 will be reassessed 9 to 15 months after their initial evaluation. The follow-up samples will include individuals who have received no formal treatment intervention during that period as well as those who have acquired hearing aids and/or participated in a program of aural rehabilitation. Outcome measures will include reassessment of communication and adjustment problems and evaluation of hearing-aid benefit. Characteristics of the treatments received and individual differences assessed in Study 1 will be related to the outcome measures. Study 3 addresses the specificity of adjustment problems associated with hearing loss by obtaining concurrent measures of selected psychological constructs on a sample of 650 cases. These will include assessment of depression, anxiety, social avoidance and distress, loneliness, anger, irrational beliefs, coping styles, and personal problem-solving. In Study 4, 550 hearing-impaired individuals and their spouses will provide independent reports of problems resulting from hearing loss. This assessment of communication and adjustment problems will be related to interpersonal communication styles and overall marital satisfaction and marital adjustment. Taken together, these four studies will contribute significantly to the base of scientific knowledge on behavioral, environmental and psychosocial aspects of adjustment to hearing loss. They will also permit prediction of individual differences in adjustment and will provide a foundation for the development of comprehensive and effective methods of treatment.